| Course | PA 533 Obstetrics & Gynecology |
|---|---|
| Week | 6 |
| Paper type | Abnormal bleeding workup |
| Length | About 660 words, 5 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | Master of Physician Assistant Studies (MPAS) |
| Updated | October 2026 |
Free sample paper for PA 533 Week 6
Abnormal Bleeding Workup for L.M. at 35, Fourteen Months After Birth: Cycles Every 21 Days, Eight Days Long, Soaking a Pad an Hour on Day 2, Pregnancy Excluded First and an Ovulatory Pattern Read Through PALM-COEIN
Student Name
Chamberlain University
PA 533: Obstetrics & Gynecology
Instructor Name
Month Day, Year
Abnormal Bleeding Workup for L.M. at 35, Fourteen Months After Birth: Cycles Every 21 Days, Eight Days Long, Soaking a Pad an Hour on Day 2, Pregnancy Excluded First and an Ovulatory Pattern Read Through PALM-COEIN
Four Terms, All Countable
Frequency: every 21 to 23 days for the past six months, since weaning.
Duration: 8 days.
Volume: on days 1 to 3, soaking a regular pad every hour for several hours, passing clots larger than a quarter, and twice bleeding through clothes at work.
Regularity: predictable; L.M. can mark the start on a calendar within two days.
Before pregnancy, L.M.'s cycles were every 30 days, five days long and lighter. These four terms follow the international system for describing bleeding, which uses frequency, duration, volume and regularity so that the next clinician can compare (Munro et al., 2018).
Two States, Not One
Before anything else, pregnancy is excluded: a urine pregnancy test today is negative. Bleeding in a pregnancy, including a miscarriage or ectopic pregnancy, needs a different workup and cannot be read with this one.
The Question That Comes First
Is L.M. stable? Pulse 84, blood pressure 118/72, no dizziness on standing. Hemoglobin 10.4 g/dL and ferritin 6 ng/mL, showing iron deficiency from blood loss. Stable, so the workup can proceed in clinic.
Ovulatory or Not
The cycles are regular and predictable, which suggests ovulation is occurring; anovulatory bleeding is usually irregular. Heavy, regular, ovulatory bleeding points toward structural causes of the uterus or problems with the uterine lining, rather than hormonal irregularity.
Through PALM-COEIN
Structural causes: polyp, adenomyosis, leiomyoma and malignancy or hyperplasia. The nonstructural half covers bleeding disorders, problems with ovulation, disorders of the lining itself, causes from treatment, and a category for everything else (Munro et al., 2018).
Polyp: possible. Adenomyosis: possible, especially after a pregnancy; L.M. has had cramping. Fibroid: possible; the uterus felt slightly enlarged and irregular on examination. Malignancy or hyperplasia: less likely at 35 with regular ovulatory cycles, but not excluded.
Coagulopathy: screened by history; no nosebleeds, gum bleeding or bleeding after the prior delivery; screening questions negative. Ovulatory dysfunction: unlikely with regular cycles. Endometrial: a diagnosis of exclusion. Iatrogenic: no anticoagulants; L.M. takes sertraline, which can very slightly affect platelet function, a minor contributor at most. Not otherwise classified: a cesarean scar defect is possible, since the first birth was by cesarean.
Age Reorders the List
At 35, structural causes lead. At 45 or older, or younger with obesity or prolonged unopposed estrogen, endometrial sampling would move up the list because hyperplasia and cancer become more likely. L.M. has a body mass index of 26 and ovulatory cycles, so sampling is not the first step but will follow if imaging is unrevealing or bleeding persists.
Next Steps
Transvaginal ultrasound to look for fibroids, polyps, adenomyosis and a scar defect. Iron replacement started today; sertraline continues, as planned in pregnancy (American College of Obstetricians and Gynecologists, 2023). Thyroid stimulating hormone checked. Contraception and treatment options will be discussed once imaging returns.
What the Ultrasound Showed
Transvaginal ultrasound two weeks later showed a 2.5 cm intramural fibroid that does not distort the cavity, a uterus with a slightly thickened and uneven back wall suggesting adenomyosis, a thin regular lining and a small niche at the cesarean scar without fluid. No polyp was seen. The thyroid level was normal. The findings support adenomyosis and a fibroid as contributors.
Treatment Options Raised
L.M. was told that a hormonal IUD can reduce bleeding substantially and treat adenomyosis symptoms, and that tranexamic acid during periods and iron replacement can help while options are weighed. Surgery is not needed at this point.
References
American College of Obstetricians and Gynecologists. (2023). Treatment and management of mental health conditions during pregnancy and postpartum (Clinical Practice Guideline No. 5). Obstetrics and Gynecology, 141(6), 1262-1288. https://doi.org/10.1097/AOG.0000000000005202
Munro, M. G., Critchley, H. O. D., & Fraser, I. S. (2018). The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions. International Journal of Gynecology and Obstetrics, 143(3), 393-408. https://doi.org/10.1002/ijgo.12666
What the PA 533 Week 6 assignment asks for
Week six asks for an abnormal bleeding workup that begins with disciplined description. Write the bleeding pattern in four countable terms: frequency, duration, volume and regularity, each as a number or plain comparison. Exclude pregnancy before anything else. Ask whether the patient is stable and check for anemia. Decide whether the pattern suggests ovulatory or anovulatory bleeding. Then work through the structural and nonstructural causes of the FIGO classification against the case, weighing each. Explain how age and risk factors reorder the list, especially for endometrial sampling. State the next steps and report imaging results if available. Close with treatment options raised. Cite the classification system.
Inside the PA 533 Week 6 example
The workup records cycles every 21 to 23 days, 8 days long, hourly soaking on days 1 to 3 with large clots and leaks at work, regular enough to calendar, compared with L.M.'s prepregnancy pattern, citing Munro and colleagues. A negative pregnancy test comes first. Vital signs are stable, but hemoglobin of 10.4 and ferritin of 6 show iron deficiency. Regular cycles suggest ovulation. Each PALM-COEIN letter is weighed, from polyp and adenomyosis to sertraline's minor platelet effect and a cesarean niche. An age section explains when endometrial sampling would move up. Next steps include ultrasound, iron and thyroid testing, with sertraline continued per the ACOG guideline. The ultrasound finds a 2.5 cm intramural fibroid, likely adenomyosis and a small niche, and IUD and tranexamic acid options follow.
PA 533 Week 6 rubric: what full points look like
The rubric starts with description. Calling bleeding heavy or irregular without numbers loses the largest share, since the next clinician cannot compare. Faculty then expect pregnancy excluded first; skipping it is a serious deduction. Stability and anemia must be addressed early. Credit goes to judging ovulatory status from the pattern. Each letter of the classification should be considered against the case, not merely listed. The age section earns marks for knowing when endometrial sampling moves up. Next steps should follow from the weighing. The classification system should be cited, and imaging results should be read against the causes considered. Treatment options raised at the end should match the causes found, not a generic list.
Common PA 533 Week 6 mistakes, and how to avoid them
Bleeding workups often lose points by jumping to fibroids or hormones without describing the pattern. Share your patient's bleeding history and test results, and the workup built from them would describe the pattern in four countable terms, exclude pregnancy, check stability and anemia, judge ovulatory status and work through the classification letter by letter. Age-based priorities, such as endometrial sampling, are applied to your patient. Next steps and imaging results are tied back to the causes weighed. If your patient is adolescent or perimenopausal, the list reorders. Describe your own patient's bleeding in numbers rather than borrowing the model's.
Get a PA-533 Week 6 example written to your instructions
Send the Week 6 case and a custom workup is written to it and returned inside 24 to 48 hours, the first one free. The case we build on is invented to fit your instructions, so nobody you have actually sat with turns up inside it. If your section supplies a history template or a required heading list, send that as well.
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PA 533 Week 6 questions, answered
Do I need numbers if the case only gives me loose descriptions?
Convert what you can and name what you cannot. A case describing heavy bleeding can be written up as a stated number of days with a stated gap between them, with an open note that volume was described rather than measured. What loses marks is reproducing the case's own vague words as though somebody had counted something.
How much of the examination belongs in the write-up?
The findings, not the inventory. A line saying a pelvic examination was performed tells a marker nothing. What the speculum showed, whether bleeding was seen coming from the cervix or from above it, and what the bimanual found are the parts the reasoning leans on later. Findings that are unremarkable can be recorded briefly and still have to be recorded.
What if the case points clearly at one explanation?
Then say so, and keep the alternatives visible anyway. A workup arriving at a confident answer still has to show what was considered and set aside, and which finding would have moved it. Certainty with no trail behind it reads as a lucky arrival, and it marks below a cautious answer that shows its working.
Where can I find a free PA 533 Week 6 sample paper?
The full PA 533 Week 6 bleeding workup is on this page, heavy regular bleeding described in four countable terms and read through PALM-COEIN.
Why does the PA 533 Week 6 sample think the bleeding is ovulatory?
The cycles are regular and predictable within two days, which suggests ovulation, pointing toward structural or lining causes rather than hormonal irregularity.